Sss Form B 304 PDF Details

In navigating the complexities of employee benefits within the Philippines, the SSS Form B-304 emerges as a critical document for both employers and employees. Crafted by the Social Security System, this form is pivotal for the process of sickness benefit reimbursement application. It mandates meticulous filling of sections to ensure accurate claim processing, encompassing details from employer's identification to employee's sickness details, and a breakdown of monetary computations for the claim. In addition to guiding parties on the correct filing process, it precisely delineates eligibility criteria, benefit computation, and the essential timings for submission. At its core, the form serves as a bridge between employers and the Social Security System, facilitating a smoother transaction in financially assisting employees during their health-related absences from work. Not only does it underscore the importance of timely and accurate premium contributions, but it also emphasizes the employer's role in supporting their employees' welfare through such mechanisms. Moreover, instructions outlined within the document further streamline its application, ensuring that both parties - the employers and the employees - understand the necessary steps to secure benefits rightfully. Thus, Form B-304 is not merely a formality but a testament to the structured approach aimed at safeguarding the well-being of the workforce within the country.

QuestionAnswer
Form NameSss Form B 304
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessss reimbursement form, sickness benefit sss form, sickness benefit application form for employed, sss sickness reimbursement form

Form Preview Example

Republic of the Philippines

 

 

SOCIAL SECURITY SYSTEM

 

 

SSS EC

DOCUMENT ITEM NO. __________________

SICKNESS BENEFIT REIMBURSEMENT APPLICATION

 

 

 

 

 

Please read instructions on page 2 before accomplishing

 

 

 

DATE FILED ______________________

 

 

this form and fill up all items except those for SSS use.

 

 

 

 

 

 

 

 

(MO - DA - YR)

 

 

 

 

 

 

 

 

 

SSS Form B-304 (6/88)

 

 

 

 

 

 

 

1

EMPLOYER (Print Registered Name)

 

 

 

2

EMPLOYER ID NO. (10 digits)

 

 

 

 

 

 

 

3

ADDRESS (Print in Full)

 

 

 

3A POSTAL CODE

 

 

 

 

 

 

 

 

4

EMPLOYEE (Surname, First Name, M.I.)

 

 

 

5

EMPLOYEE SS NO. (10 digits)

 

 

 

 

 

 

 

 

 

6 ADDRESS (Print in Full)

 

 

 

7

DATE OF COVERAGE

 

 

 

 

 

 

 

 

FOR SSS USE

H

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

 

(MAIL CODE)

 

CITY CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

8DATE WHEN (Exact Dates: MO - DA - YR)

(a)EMPLOYEE became sick or injured and stopped working

(b) EMPLOYEE returned to work

9CONFINEMENT AS APPROVED BY MEDICAL DEPARTMENT (CLD-9N)

(a) Started on (MO - DA - YR)

 

(b) Up To - Last Day (MO -DA - YR)

 

 

 

 

(c) Number of Days

10COMPANY SICK LEAVES PAID DURING CONFINEMENT (CURRENT SICK LEAVE WITH FULL PAY ONLY)

(a) Started on (MO - DA- YR)

 

(b) Lasted Up To (MO - DA - YR)

 

(c) Number of Days

 

 

 

 

 

 

 

11 SIX HIGHEST MONTHLY SALARY CREDITS

12

COMPUTATION

 

 

 

 

(See Letter B, C, & D at the back)

 

 

 

 

Year

 

Applicable Month

 

Salary Credit

(a)

TOTAL MSC

____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(b)

DIVIDED BY 180 =

____________

 

 

 

 

 

 

 

(c)

AVERAGE DAILY SALARY CREDIT

____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(d)

MULTIPLIED BY 90%

____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(e)

DAILY SICKNESS ALLOWANCE

____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(f)

MULTIPLIED BY NO. OF DAYS

____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(g)

COMPENSATION DUE

____________

 

 

 

 

 

 

 

 

* Number of days should be actual number of confinement days

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(after deducting company sick leave) or number of approved

 

 

 

 

 

 

 

 

TOTAL MONTHLY SALARY CREDITS P ____________

 

confinement days, whichever is less.

 

13 CERTIFICATION

This is to certify that

(a)This employer has actually paid the corresponding premium contributions for the above months.

(b)This employer has actually paid this employee sickness benefits for above confinement in the amount of _____________________________________________________ (P _____________) on ________________, 19 _______________

PRINTED NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF EMPLOYEE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF EMPLOYER REPRESENTATIVE

 

 

 

 

 

 

 

 

 

 

(DO NOT SIGN IF AMOUNT IS NOT ACTUALLY ADVANCED)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE ACCOMPLISHED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OFFICIAL DESIGNATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR SSS USE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Processed by:

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO BE FILLED BY EMPLOYER-CLAIMANT

 

 

 

 

 

ACKNOWLEDGMENT RECEIPT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYEE

 

SS NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERIOD APPLIED FOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From ______________________

 

To ______________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DO NOT FILL

OTHER DOCUMENTS SUBMITTED

SSS Form CLD-9N

SSS Form EC-N

Others

Date Filed

Received By

Internet Edition (7/2000)

INSTRUCTIONS IN ACCOMPLISHING THIS FORM:

1.Answer properly items 1 to 13 of the Sickness Benefit Reimbursement Application (SSS Form B-

304)including the Acknowledgment Receipt.

2.Submit only one copy.

3.Approved sickness notification (SSS Form CLD-9N) should always be attached to the Sickness Benefit Reimbursement Application.

4.Alterations should always be initialed by the employer or his authorized representative.

REMINDER:

1.Employers should file their application for reimbursement within one year from the last day of confinement, if member is confined in a hospital. Otherwise, the recknoning date is from the start of confinement if member is confined at home.

2.Minimum benefits -- SSS - P30.00/day EC - P10.00/day

Maximum benefits --

SSS- P360.00/day EC - P200.00/day

HOW TO COMPUTE SICKNESS BENEFITS:

1.Exclude the semester of sickness (contingency).

2.Select the six highest monthly salary credits (MSC) within the last 12-month period preceding the semester of sickness (contingency). Get the total of the selected MSC.

3.Divide the total MSC by 180 days to arrive at the average daily salary credit (ADSC).

4.Multiply the ADSC by 90%.

EXAMPLE: 1. Contingency -- July 2, 1998 to August 30, 1998 (29 days)

a)April 1998 to September 1998 would be the semester of contingency.

b)April 1997 to March 1998 would be the 12-month period prior to the semester of contingency.

c)P60,000 would be the total MSC within the 12-month period if the MSC is P10,000 for every month (P10,000 x 6).

d)P333.33 would be the ADSC (P60,000/180).

e)The daily sickness allowance would be 90% of P299.99 or P300.

f)Compensation due is arrived at by multiplying P300 by 29 days or P8,700.

FOR EC CLAIMS ONLY

HOW TO COMPUTE SICKNESS BENEFITS OF A MEMBER COVERED FOR LESS THAN 12 MONTHS

1.Exclude the month of sickness or injury.

2.Add all the monthly salary credits from coverage to month immediately preceding the month of sickness or injury.

3.Divide the sum of all the MSC (in item 12) by 30 times the number of coverage excluding the month of sickness and multiply the quotient by 90%.

HOW TO COMPUTE SICKNESS BENEFITS WHEN CONFINEMENT OCCURRED WITHIN THE MONTH OF COVERAGE

1.Add all the earnings from the first day of employment up to the day immediately preceding the initial date of confinement and convert the total earnings into salary credit.

2.Divide the monthly salary credits by 30 and multiply the quotient by 90%.

How to Edit Sss Form B 304 Online for Free

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With regards to the blanks of this particular document, here's what you want to do:

1. It is important to fill out the sss sickness reimbursement form correctly, hence pay close attention while filling in the segments that contain these specific blank fields:

Stage no. 1 in submitting sickness benefit sss form

2. Soon after the previous part is done, go on to enter the suitable details in these: COMPANY SICK LEAVES PAID DURING, c Number of Days, a Started on MO DA YR, b Lasted Up To MO DA YR, SIX HIGHEST MONTHLY SALARY CREDITS, COMPUTATION, Year, See Letter B C D at the back, Salary Credit, TOTAL MONTHLY SALARY CREDITS P, CERTIFICATION, TOTAL MSC, DIVIDED BY, AVERAGE DAILY SALARY CREDIT, and MULTIPLIED BY.

Filling out segment 2 of sickness benefit sss form

Be really careful when completing SIX HIGHEST MONTHLY SALARY CREDITS and See Letter B C D at the back, as this is where a lot of people make a few mistakes.

3. Through this stage, have a look at a This employer has actually paid, PRINTED NAME, SIGNATURE OF EMPLOYEE, SIGNATURE OF EMPLOYER, DO NOT SIGN IF AMOUNT IS NOT, DATE ACCOMPLISHED, OFFICIAL DESIGNATION, FOR SSS USE, Processed by, Date, TO BE FILLED BY EMPLOYERCLAIMANT, ACKNOWLEDGMENT RECEIPT, EMPLOYEE, SS NO, and ADDRESS. Each one of these should be taken care of with highest attention to detail.

Filling in segment 3 of sickness benefit sss form

Step 3: Prior to finalizing your form, ensure that all form fields are filled in the right way. When you think it's all good, press “Done." Make a 7-day free trial subscription at FormsPal and get direct access to sss sickness reimbursement form - which you can then work with as you would like from your FormsPal account page. We do not sell or share any information that you use while filling out documents at FormsPal.

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